4 1 burkett4.htm OCTOBER 25 ACQUISITION Converted by FileMerlin

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

Washington, D.C.  20549


STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP


Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,

Section 17(a) of the Public Utility Holding Company Act of 1935 or

Section 30(h) of the Investment Company Act of 1940


[ ] Check this box if no longer subject to Section 16.  Form 4 or Form 5 obligations may continue.  See Instruction 1(b).  


1.  Name and Address of Reporting Person*




Burkett Robert

2.Issuer Name and Ticker or Trading Symbol


Cytomedix, Inc.

CYME

6. Relationship of Reporting Person(s) to Issuer (check all applicable)

[X] Director [ ] 10% Owner  

[ ] Officer   [ ] Other:

(give title below)  

(Last) (First)



19 Rock Hill Lane

3. I.R.S. Identification Number of Reporting Person, if an entity

(Voluntary)

4.  Statement for Month/Day/Year

10/25/2002

7.  Individual or Joint/Group Filing

[X] Form filed by One Reporting Person

[ ] Form filed by More than One Reporting Person

(Street)





Scarsdale, NY 10583

(City) (State) (Zip)









5.If Amendment, Date of Original (Month/Day/Year)

 

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1.  Title of Security

(Instr. 3)

2. Transaction Date (Month/Day/Year)

2A. Deemed Execution Date, if any (Month/Day/Year)

3. Transaction Code

(Instr. 8)

4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)

5. Amount of Securities Beneficially Owned Following Reported Transaction(s)

(Instr. 3 and 4)

6. Ownership Form:  Direct (D) or Indirect (I)

(Instr. 4)

7. Nature of Indirect Beneficial Ownership

(Instr. 4)

Code

V

Amount

(A) or (D)

Price

Common Stock

10/25/2002

 

A

 

32,481

A

n.1

56,865

D

N/A


Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4(b)(v).


Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned

(e.g. puts, calls, warrants, options, convertible securities)



1. Title of Derivative Security

(Instr. 3)

2. Conversion or Exercise Price of Derivative Security

3. Transaction Date (Month/Day/Year)

3A. Deemed Execution Date, if any

(Month/Day/Year)

4. Transaction Code

(Instr. 8)

5. Number of Derivative Securities Acquired (A) or Disposed of (D)

(Instr. 3, 4, and 5)

6. Date Exercisable and Expiration Date (Month/Day/Year)

7. Title and Amount of Underlying Securities

(Instr. 3 and 4)

8. Price of Derivative Security (Instr. 5)

9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)

10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)

(Instr. 4)

11. Nature of Indirect Beneficial Ownership

(Instr. 4)

Code

V

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

Option to Purchase Common Stock

$1.50

8/07/2002

 

A

V

Option representing  100,000 shares

N/A

8/07/2002

8/07/2012

Common Stock

100,000 shares

n.2

Option representing  100,000 shares

D

N/A


Explanation of Responses:

note 1 - Grant from Issuer pursuant to the reorganization bonus described in the Issuer’s Plan of Reorganization.

 

Note 2 - Grant from Issuer pursuant to the Cytomedix, Inc. Long-Term Incentive Plan.


Robert Burkett


/s/Robert Burkett

**Signature of Reporting Person


Date: October 28, 2002


** Intentional misstatements or omissions of facts constitute Federal Criminal Violations.

See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).